Diabetes-related outcomes after pancreatic surgery.

BACKGROUND: The development of pancreatogenic diabetes mellitus (PDM) is a common complication post-pancreatectomy; however, its prevalence has not been described in Australia. We aimed to describe the glycaemic status pre- and post-pancreatectomy, compare patients' clinical characteristics, group according to pre- and post-pancreatectomy diabetes mellitus (DM) status and identify predictors of post-operative PDM. METHODS: We retrospectively reviewed the medical records of patients admitted for pancreatic resection at a single institution from 2011 to 2017. Post-operative DM status was determined at the time of discharge or at 30 days post-operation. Longer term DM onset was as documented in medical record subsequent to admission for pancreatic surgery. RESULTS: A total of 137 cases were analysed; 13.3% and 24.8% of patients developed post-operative PDM within 30 days and at median of 1 year (range 1-4 years) follow-up, respectively. All patients with pre-existing DM continued to have DM post-operatively. Patients with pre-existing DM were older (P = 0.004) and had a family history of DM (P = 0.020); 8.3% of patients who had undergone pancreaticoduodenectomy versus 17.1% of patients who had undergone distal pancreatectomy developed PDM (P = 0.318). A lower estimated glomerular filtration rate (P = 0.033) was significantly associated with post-operative PDM development. No independent predictors for post-operative PDM were identified. CONCLUSIONS: The new development of DM within 30 days post-pancreatectomy occurs in approximately one in seven persons. No patients with pre-existing DM demonstrated a remission of DM post-pancreatectomy. These findings suggest that all patients should be screened for DM pre-operatively and followed up post-operatively, particularly those with pre-existing impaired renal function.

Acute renal failure and metformin-associated lactic acidosis following colonoscopy.

Two patients with type 2 DM developed acute kidney injury and lactic acidosis following colonoscopy despite withholding metformin. We recommend that DM patients on metformin also withhold ACEI, ARB until their dehydration is reversed after colonoscopy. This should reduce the risk of acute renal failure (ARF) and of lactic acidosis.

Triggers to offering bariatric surgery in the management of type 2 diabetes.

It is unclear how current guidelines suggesting bariatric surgery as a therapeutic option for management of obesity complicated by type 2 diabetes mellitus are utilised in clinical practice. Of 609 patients with T2DM assessed in this study, 147 had a BMI ≥ 35 kg/m2; and of these 147, patients where bariatric surgery had been discussed as compared to those where it had not been discussed, had a higher BMI (44.4 ± 6.8 kg/m2 versus 40.3 ± 5.2 kg/m2, p < 0.005). Diabetes related factors did not differ between the two groups.

Effect of comorbid diabetes on length of stay and risk of death in patients admitted with acute exacerbations of COPD.

BACKGROUND AND OBJECTIVE: Hyperglycaemia during hospital admission is associated with poor outcomes in patients admitted with acute myocardial infarction, stroke and pneumonia. Less evidence exists for effect of diabetes mellitus (DM) on those admitted with an acute exacerbation of COPD (AECOPD). We proposed that comorbidity with DM is associated with an increased length of stay in patients admitted with AECOPD. METHODS: Records of patients admitted with AECOPD during 2007 were reviewed. Data on the presence of diagnosed DM, length of stay and markers of disease severity and other comorbidities were collected. Analysis was performed using generalized estimating equations to adjust for correlation between multiple admissions in some individuals. Log-transformed length of stay and death were the dependent variables. RESULTS: There were 246 admissions in 172 subjects. Diabetes was a comorbid condition in 22% of admissions for AECOPD. There was a trend for increased length of stay and deaths in those with diabetes (geometric mean 7.8 days and 8% mortality respectively) compared with those without diabetes (6.5 days and 4%). However, after adjustment for covariates, the differences were not statistically significant. CONCLUSIONS: Taken together with a previous study that revealed a similar trend, our study suggests that comorbid DM prolongs length of stay and increases risk of death in patients with AECOPD. Further studies are now required to elucidate the reasons for these poorer outcomes, in particular whether premorbid glycaemic control or inpatient control is responsible, as these are potentially modifiable factors.